| NPI | 1306513353 |
|---|---|
| Former Name | TINA MARIE VELAZQUEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61399966) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA 60966141) |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2025-01-15 |